Haematologica 2003 - Supplements

More documents

Recommendations

Info

200 Presentation and outcome of multiple myeloma in elderly patients: A prospective single center study Rodon Philippe (1), Giraudeau Bruno (2), Estepa Laurence (1), Yvon Patrice (1), Akpo-Avallo Jacques (1), Friocourt Patrick (1) (1) Unité d`Hématologie, Département de Médecine Interne, Centre Hospitalier, Blois, France(2) Centre d`Investigation Clinique, Faculté de Médecine, Tours, France Few data exist concerning multiple myeloma (MM) in elderly patients (pts). We reported a multicenter retrospective study including pts with MM aged 75 years or more at diagnosis (Rodon et al, Eur J Haematol 2001; 66: 11-17). Median survival was 22 months. Age ≥85 years, Performance Status (PS) ECOG ≥2 and creatinine level ≥120 mcmol/l were identified as independent prognostic factors. However, inclusion bias were possible. In order to confirm these results, we analyzed survival and prognostic factors of all consecutive elderly pts with MM included in a prospective database in a single center from January 1985 to December 2002. One hundred and three pts were included (M: 51, F: 52). Median age at diagnosis was 81 years (range 75-97). Twenty six pts were 85 years or older. According to the Durie and Salmon (DS) staging, 26 pts had stage I, 23 pts stage II and 53 pts stage III MM. Immunochemical subtype was IgG in 58 pts, IgA in 31 pts, light chain in 11 pts, other in 3 pts. Light chain was kappa in 62 pts, lambda in 40 pts, absent in 1 pt. Forty five significant comorbid diseases were recorded (cardiovascular 16, neurological 9, 2nd malignancy 8, other 12) in 41 pts. Infection at diagnosis was found in 23 pts. Twenty seven pts remained untreated [asymptomatic DS stage I: 18 pts, stage II-III: 9 pts (heavy comorbidity: 3, poor condition: 3, other: 3)]. In 76 treated pts, initial treatment was a combination of an alkylating agent and corticosteroids in 69 pts, other in 7 pts. Response was defined as a reduction ≥25% in M spike level. Forty five pts were responders, 10 pts were non responders, early death (ED) (
(β2m) & C reactive protein (CRP). Erythrocyte sedimentation rate (ESR), tumor necrosis factor ∝ (TNF∝) and serum copper (Co) were also analysed. Overall survival (OS) was performed by Kaplan-Meier curves and subgroups were compared with the logrank test. Results: 27 pts have been eligible, male-female ratio 15/12, median age 74 (59-87): only 18% pts were 100mmHg. There was a significant (p= 0.045) correlation between ESR and Co. Raised β2m, TNF∝ and CRP were demostrated in 80%, 79% and 44%. Only one pt could reach high dose therapy and autologous stem cell transplant (but he relapsed 20 months later). Median OS has been 32.25 months. As might be expected, we have seen shorter OS (p=0.043) for pts with β2m >4 mg/dl vs 25% reduction). 10 of these 12 patients had day 28 SFL analysis with 3/10 patients continuing to respond, 1 patient showing an increase in SFL and 6 patients showing no further improvement in SFL levels. Paraprotein measurements taken at day 28, showed a decrease in value (>25%) in 8/21 patients (38%). This was compared directly to the free light chain results. Of these 8 patients, 5 had either a day 7 or day 14 sample for sfl analysis, and all 5 patients showed a response in SFL levels by day 14. A further 5 patients showed a delayed response (>28 days) to treatment with a median time to best response of 5 months. In this group 4 patients had day 7 or 14 samples for sfl levels which showed a reduction in 3 patients and no change in 1 patient. Conclusions: The use of the serum free light chain assay at early time points in the treatment regime may predict for overall response rate. Further studies are being undertaken to validate these findings to see if an early fall in SFL levels can be used to stratify those patients who will respond well to treatment with the IMID CC-4047. 204 PROGNOSIS IN MULTIPLE MYELOMA (MM) UNDER CONVENTIONAL CHEMOTHERAPY. A MULTIVARITE ANALYSIS OF A SERIES INCLUDING 644 PATIENS. MI González-Fraile, R García-Sanz, JM Hernández, MJ Moro, J Fernández-Calvo, F Ortega, A Bárez, J Galende, RM López, JA Portero, MD Caballero, M González, JF San Miguel. Castellano-Leonés (Spain) Group for the Study of Monoclonal Gammapathies. Hematology Department. University Hospital of Salamanca. Background: Many clinical and biological variables are of prognostic value in MM. However, most studies are incomplete and lack on the analysis of several important variables. Methods: In this study we analyzed the prognostic value of several clinical and biological characteristics at diagnosis and their impact on the overall survival in a series of 644 MM patients treated without high dose therapy. Results: The univariate analysis of the whole series identified 22 parameters studied at diagnosis that negatively influenced overall survival: age >60 yr, plasma cell (PC) infiltration >10% assessed by flow cytometry (FC) or >20% by morphology, ECOG performance status ≥3, S-phase PC >3%, 2M >6 mg/L, LDH >460 U/L, albumin ≤3.5 g/dL, advanced osteolytic bone lesions, Durie & Salmon stage III, only light chain secretion, light chain subtype, creatinine >2 mg/dL, urea >65 mg/dL, CRP >6 mg/dL, calcemia ≥11.5 mg/dL, light chain proteinuria >1.8 g/day, hemoglobin ≤8.5 g/dL, platelets100·109/L, plasma cell DNA index 3%, BMPC by FC >10%, ECOG 3, age >60 yr, β2M >6 mg/L, LDH >460 U/L and albumin ≤3.5 g/dL. The combination of these seven factors allows making a powerful prognostic system for the whole series discriminating three different prognostic groups. Conclusions: The present analysis of prognostic factors displayed seven variables with an independent influence on survival in MM reflecting that it remains as a heterogeneous disease. These factors could be categorized into three groups: related to the host S178
Page 1 and 2:
Focussed Symposia Arsenic trioxide
Page 3 and 4:
assess whether such a program will
Page 5 and 6:
The overall response rate was noted
Page 7 and 8:
Figure 5A Table 1: VEL + THAL for R
Page 9 and 10:
naturally occurring OPG. Present tr
Page 11 and 12:
0.505). Finally, the multiple event
Page 13 and 14:
CLINICOPATHOLOGICAL DEFINITION OF W
Page 15 and 16:
Plenary Sessions 1. Development of
Page 17 and 18:
clonotypic IgH VDJ signature confir
Page 19 and 20:
can be considered as two entities,
Page 21 and 22:
immunofluorescence staining for DKK
Page 23 and 24:
P2.3 DEVELOPMENT OF A MULTIPLE MYEL
Page 25 and 26:
P2.5 MOLECULAR CYTOGENETICS OF MYEL
Page 27 and 28:
clear that the biggest challenge fo
Page 29 and 30:
esponse and have demonstrated that
Page 31 and 32:
variable region of the idiotypic im
Page 33 and 34:
4. From MGUS to symptomatic MM Fig.
Page 35 and 36:
(MRI); some have claimed that level
Page 37 and 38:
P4.5 CYTOKINES IN MGUS: THERAPEUTIC
Page 39 and 40:
preventing phosphorylation of p70S6
Page 41 and 42:
transducing component of the interl
Page 43 and 44:
survive initial drug exposure and a
Page 45 and 46:
quiescent counterpart, the human um
Page 47 and 48:
transcriptional activity of NF-êB;
Page 49 and 50:
manifestations and anomalous protei
Page 51 and 52:
P7.4 ROLE OF SERUM FREE LIGHT CHAIN
Page 53 and 54:
P7.6 IMMUNOPHENOTYPIC INVESTIGATION
Page 55 and 56:
presumably through the circulation,
Page 57 and 58:
9. Chemotherapy, maintenance treatm
Page 59 and 60:
stratified according to their antim
Page 61 and 62:
explore higher doses of zoledronic
Page 63 and 64:
initial therapy. However, the role
Page 65 and 66:
P10.2.2 SINGLE VERSUS TANDEM HIGH D
Page 67 and 68:
With a median follow-up of 38 month
Page 69 and 70:
cells could be harvested following
Page 71 and 72:
11. What is the role of allogeneic
Page 73 and 74:
found that 75% of patients who were
Page 75 and 76:
patients with responsive disease 3
Page 77 and 78:
9. Giralt S, Estey E, Albitar M, et
Page 79 and 80:
Badros A, Barlogie B, Siegel E, et
Page 81 and 82:
Figure 3b. Event-free Survival 4-Ye
Page 83 and 84:
improve patient outcome in MM. Impo
Page 85 and 86:
myeloma and in 40% of previously un
Page 87 and 88:
degrade OPG in the same way as myel
Page 89 and 90:
P12.2.5 MONOCLONAL ANTIBODY THERAPY
Page 91 and 92:
myeloma. Blood 2001; 98:210-216. 6.
Page 93 and 94:
MHC molecules, in effectively prese
Page 95 and 96:
mice demonstrate that class II-spec
Page 97 and 98:
detected in 293 and NIH3T3 cells. S
Page 99 and 100:
hypothesis that (1) CCND1 and FGFR3
Page 101 and 102:
patient samples. In addition, the p
Page 103 and 104:
016 NEUTRAL ENDOPEPTIDASE (CD10) KN
Page 105 and 106:
2. Genetic heterogeneity in MM: imp
Page 107 and 108:
evidence from two t(11;14) cases wh
Page 109 and 110:
immunoglobulin heavy chain (IgH) lo
Page 111 and 112:
034 Instability of Pericentromeric
Page 113 and 114:
clusters were found, the first was
Page 115 and 116:
MGUS but most likely not crucial fo
Page 117 and 118:
Objective: To compare the impact on
Page 119 and 120:
4 patients had MMSET/IgH but did no
Page 121 and 122:
and clonal PC from MGUS, MM and PCL
Page 123 and 124:
059 VEGF receptor expresion in Mult
Page 125 and 126:
two HLA-A2+ myeloma patients with C
Page 127 and 128:
molecules expressed on the surface
Page 129 and 130:
Recognition of these antigens appea
Page 131 and 132:
Diagnosis requires a single area of
Page 133 and 134:
081 Incidence of solid tumors in co
Page 135 and 136: Growth Factor (VEGF), Hepatocyte Gr
Page 137 and 138: PC-AI levels of MGUS and SMM patien
Page 139 and 140: 093 The predominant pathway of tran
Page 141 and 142: was associated with I.V. line, whil
Page 143 and 144: 103 Vascular amyloidosis induces se
Page 145 and 146: 5. Signal transduction pathways and
Page 147 and 148: integrin in IGF-1-triggered MM cell
Page 149 and 150: 118 IL-6- Induced Phosphorylation o
Page 151 and 152: 123 THE IGF/IGF-1R SYSTEM IS A MAJO
Page 153 and 154: human myeloma cell line (HMCL) to a
Page 155 and 156: ligation or dexamethasone (Georgii-
Page 157 and 158: 6. Role of microenvironment 6.1 Cel
Page 159 and 160: 141 Human myeloma cells adhere to f
Page 161 and 162: 145 STUDY OF BONE MARROW ANGIOGENES
Page 163 and 164: patients, the growth of primary mye
Page 165 and 166: tibia (con=49.1±0.7mg/cm2 vs 5T2=4
Page 167 and 168: 157 The Nitrogen-Containing Bisphos
Page 169 and 170: 7. New prognostic criteria for clas
Page 171 and 172: atio of >3. This system has subdivi
Page 173 and 174: Patient 1 (IgG/κ);IgG - 16.5 days,
Page 175 and 176: 176 Pro-inflammatory and angiogenic
Page 177 and 178: 180 Clinical study on the bone lesi
Page 179 and 180: 7.2 Imaging studies 185 99mTc-MIBI
Page 181 and 182: 189 Factors Predicting Occult Spina
Page 183 and 184: vivo detected resonances was invest
Page 185: Support Unit (CTSU) with flexibilit
Page 189 and 190: plasmids carrying the clonotypic in
Page 191 and 192: newly diagnosed multiple myeloma as
Page 193 and 194: 216 Transgenic expression of Myc an
Page 195 and 196: 221 Prolonged survival in the 5T2MM
Page 197 and 198: 9. Chemotherapy, maintenance, treat
Page 199 and 200: 229 EFFECTIVENESS OF STANDARD CHEMO
Page 201 and 202: 234 Melphalan and Dexamethasone- Is
Page 203 and 204: Methods. We investigated the VECD p
Page 205 and 206: 9.2 Renal complications. 243 MERIT
Page 207 and 208: cost of SRE-related care was $10,24
Page 209 and 210: those with Hb >13 g/dL. Analysis of
Page 211 and 212: sustained response, lasting from 52
Page 213 and 214: proportion of bone abnormality. IgD
Page 215 and 216: disease. The lack of response to in
Page 217 and 218: yielding a median of 3x106/kg CD34
Page 219 and 220: patients(pts) aged ≥60 yrs. We co
Page 221 and 222: PBSC mobilizing regimen utilizing C
Page 223 and 224: their leukocytes and platelets. No
Page 225 and 226: 25 Gy to marrow. The tracer dose wa
Page 227 and 228: non-CR after the first transplant a
Page 229 and 230: 296 PERIPHERAL BLOOD STEM CELL TRAN
Page 231 and 232: References Effect of dose-intensive
Page 233 and 234: with cyclosporine A and methotrexat
Page 235 and 236: 11.Role of novel therapies targetin
Page 237 and 238:
312 Thalidomide as Rescue of Relaps
Page 239 and 240:
patients, light chain in 1 patients
Page 241 and 242:
platelets of 207 (76-402), B2M of 3
Page 243 and 244:
325 Low Dose Thalidomide plus Dexam
Page 245 and 246:
in 5 pts (11%), M protein decreased
Page 247 and 248:
time from diagnosis was 3.7 years a
Page 249 and 250:
339 Thalidomide, Clarithromycin and
Page 251 and 252:
344 COMBINATION OF THALIDOMIDE, DEX
Page 253 and 254:
experienced early death during the
Page 255 and 256:
untreated patients with high tumor
Page 257 and 258:
357 Thalidomide protects endothelia
Page 259 and 260:
362 EOSINOPHILIA IS A VERY COMMON F
Page 261 and 262:
11.5 CC 4047, PS 341 and arsenic tr
Page 263 and 264:
without chromosome 13. Mean IC50 fo
Page 265 and 266:
myeloma patients. Phase I data indi
Page 267 and 268:
11.6 Other drugs 380 EFFECT OF STI5
Page 269 and 270:
significant inhibition of cell prol
Page 271 and 272:
which acts to prevent the synthesis
Page 273 and 274:
of B and its metabolites, however,
Page 275 and 276:
and 10 months after start of therap
Page 277 and 278:
terminal kinase (JNK) pathway which
Page 279 and 280:
lymphocytes was tested by Ellispot.
Page 281 and 282:
411 Dendritic Cell-Based Idiotype V
Page 283 and 284:
Author Index Abe M 74 160 Abelman W
Page 285 and 286:
De La Serna J 291 De Laurenzi A P11
Page 287 and 288:
Hull DR 338 Hullen C P10.2.1 Humes
Page 289 and 290:
Morra E 249 280 359 Morris CM 226 M
Page 291 and 292:
Siegel D 70 115 250 Sierra J 304 30
show all

Haematologica 2003 - Supplements

Create successful ePaper yourself

Delete template?

Save as template?